Ileana Hernandez of Manatt Discusses The Problems Of Healthcare Fraud and Prosecution in The USA

Healthcare fraud has been on the rise even after significant changes were incorporated into the nation’s medical system by former President Trump and President Biden. Unfortunately, the COVID-19 Pandemic increased the number of legal and regulatory disputes, and now the nation needs to battle fraudulent activities even stronger than before.

Developments and new processes by the USA Government have been incorporated. However, they are still not enough to eliminate the issue. The problem is so concerning that leaders of political parties have even forgotten their differences and joined hands with the Government to battle the problem and boost legal prosecution extensively.

Ileana Hernandez of Manatt explains how the COVID-19 Pandemic made healthcare fraud in the USA worse

Ileana Hernandez, a partner with Manatt Phelps & Phillips Law Firm and an active member of the firm’s healthcare litigation practice, says, “With the introduction of new programs such as the CARES act Provider Relief Fund, the United States government has placed a high priority on monitoring cases of potential fraud in federal programs and are determined to recover money lost due to false claims,”

There have been massive nationwide sweeps conducted by the US Department of Justice (DOJ), where healthcare fraud estimated to be $900M and $1.3B in false claim billings detected. Moreover, nearly 500 cases under the Federal Government have been filled by private individuals in the country.

Ileana Hernandez of Manatt says, “Recent activities demonstrate the government’s fierce determination to monitor and prosecute healthcare fraud cases.”

“In the current healthcare climate, nobody is immune to the government’s efforts to stomp out cases of healthcare fraud and abuse, and they will go to any length to recoup monies and prosecute entities,” she adds.

Legal enforcement trends have been revamped

Healthcare fraud is grave in the nation and has forced the Government to launch major changes in their legal enforcement practices. Though they saw the light of the day much before the coronavirus pandemic took over the globe, cases surged due to new infections caused by the mutant strains of the virus.

“The Individuality Accountability for Wrongdoing” Memo that was originally rolled out in 2015 by Sally Yates, the United States Deputy Attorney General, directed every attorney in the USA to aggressively prosecute individuals involved in corporate crimes, including the healthcare sector.

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These legal enforcement trends in the investigation and prosecution conducted by the Federal Governments include litigation focusing on-

  • Alleged medical necessity
  • Environments involving managed care
  • Eliminating the opioid epidemic (this problem has even caught the attention of the Government and USA media in the USA)

Accountability in fraudulent healthcare activities is one of the key legal enforcement trends in this sector today. When multiple False Claim settlements were imposed in the nation, the healthcare sector had to wake up and take notice. Most of these settlements cost healthcare companies and their executives millions of dollars.

Ileana Hernandez of Manatt sums up to saying, “These cases are becoming more common and aggressively investigated on the federal level.” For example, owners of a Los Angeles-based acute care hospital in Los Angeles paid $42M to settle FCA violation allegations that they offered kickbacks to referring physicians. In Missouri, healthcare practitioners paid $34M to settle violations of submitting false claims to Medicare for chemotherapy services.”